Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialised hospital, northwest Ethiopia: a prospective observational cohort study Nahom Worku Teshager,1 Ashenafi Tazebew Amare,1 Koku Sisay Tamirat 2 To cite: Teshager NW, Amare AT, Tamirat KS. Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialised hospital, northwest Ethiopia: a prospective observational cohort study. BMJ Open 2020;10:e036746. doi:10.1136/ bmjopen-2019-036746 ► Prepublication history for this paper is available online. To view these files, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2019- 036746). Received 03 January 2020 Revised 10 August 2020 Accepted 21 September 2020 1Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia 2Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Correspondence to Koku Sisay Tamirat; kokusisay23@gmail.com Original research © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Objective To determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia. Design A single-centre prospective observational cohort study. Participants A total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period. Measurements Data were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality. Result The median age at admission was 48 months with IQR: 12–122, 28.1% were infants and adolescents accounted for 21.4%. Of the total patients studied, 59.7% were males. The median observation time was 3 days with (IQR: 1–6). One hundred and two (32.6%) children died during the follow-up time, and the incidence of mortality was 6.9 deaths per 100 person-day observation. Weekend admission (adjusted HR (AHR)=1.63, 95% CI: 1.02 to 2.62), critical illness diagnoses (AHR=1.79, 95% CI: 1.13 to 2.85), need for MV (AHR=2.36, 95% CI: 1.39 to 4.01) and modified PIM 2 Score (AHR=1.53, 95% CI: 1.36 to 1.72) were the predictors of mortality. Conclusion The rate of mortality in the PICU was high, admission over weekends, need for MV, critical illness diagnoses and higher PIM 2 scores were significant and independent predictors of mortality. INTRODUCTION Though paediatric intensive care units (PICUs) are essential areas of service to save the lives of children with acute neurological deterioration, respiratory distress, cardiovascular compromise, severe infections, accidental poisoning and other life-threatening conditions; organisational details of paediatric ICUs in low-income settings are lacking.1 2 Published data on paediatric critical care in low-income countries remain sparse, making practice modification and outcome improvement difficult. Also, most studies done on predictors of mortality in the PICUs are from high-income countries and are dependent on clinical and laboratory indices, which are not readily available in low-income countries.3 The few studies that considered epidemiologic and sociodemographic factors were retrospective and cross-sectional, and most did not consider essential parameters.4 Determining the risk factors of mortality among children admitted to the paediatric intensive care will be crucial to prioritise and tunnel resources to the most fruitful practice based on the prediction of patient outcomes, especially in resource-limited setups such as ours. This study aimed to determine the incidence and predictors of mortality among Strength and limitation of this study ► This study was a prospective cohort study and had used better statistical functions (survival analysis) for better estimation and prediction of mortality. ► This study could help clinicians and healthcare planners practice evidence-based medicine in a resource-limited setting such as ours. ► The Pediatric Index of Mortality 2 scoring was done based on 9 out of 11 parameters as there was no arterial blood gas analyser in our set-up during the study period that might result in misclassification. BMJ Open: first published as 10.1136/

Abstract

Objective To determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia. Design A single-centre prospective observational cohort study. Participants A total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period. Measurements Data were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality